Hypertension and Hyperinsulinemia

Hypertension is defined as the sustained elevation of either or both systolic and diastolic blood pressure while at rest. There are several different classifications of hypertension, but the two main categories are primary, also called essential hypertension, and secondary hypertension. The majority of all those diagnosed with hypertension fall under the primary category while only a small percentage are classified as secondary hypertensive. Secondary hypertension is the result of some other condition or disease where as primary

Hypertension
is said, by conventional medicine, to have no identifiable cause for development.

An overwhelming number of studies have revealed that diet, obesity and vitamin
and mineral deficiencies are related to primary hypertension. Changes in lifestyle
and the uses of specific supplements have proven to be extremely effective in
the treatment and reversal of mild primary hypertension and could be considered
prior to the use of prescription drugs

Hypertension is strongly associated with the development of cardiovascular
disease and is one of the major factors in the incidences of heart attacks in
both the diabetic and non-diabetic population. It can also contribute to the
progression of atherosclerosis. Numerous studies show a definite correlation
between hypertension, diabetes, hyperglycemia, atherosclerosis and cardiovascular
disease.[i] [ii]

We are most interested in the links between diabetes and hypertension and how
to prevent and or treat them accordingly.

Type I diabetes patients usually develop secondary hypertension while Type
II patients are associated with primary hypertension. Secondary hypertension
in Type I patients is usually the result of nephropathy often caused by chronic
hyperglycemia. Type II diabetes patients can also develop secondary hypertension
from nephropathy, but it is not as common.

The cause of primary hypertension in Type II patients as well as non-patients
has been under investigation for some time without any real agreement on the
subject.

Hypertension, like other conditions, has several factors involved in its pathology
and just as one individual event probably did not cause it, one type of treatment
is not likely to cure it. The greatest single factor in the development of primary
hypertension, which had been suggested over 30 years ago, is the condition of
hyperinsulinemia.[iii] [iv] [v]

Hyperinsulinemia can be caused by insulin resistance, which creates elevated
glucose levels due to glucose intolerance. The pancreas tries to correct this
by massively increasing insulin production, which leaves high levels of serum
insulin that are not utilized. One of the many effects of this over production
is the increased re-absorption of sodium by the kidneys.[vi] This causes increased
extracellular fluid volume, which will demand greater cardiac output and raise
blood pressure. There are also several other pathways in which sustained elevated
levels of insulin can stimulate the sympathetic nervous system and increase
peripheral vascular resistance and raise blood pressure.

Hyperinsulinemia can also be caused by the uses of injected insulin. The hyperbolized
amount of injected insulin needed to eventually make its way to the vascular
system can increase insulin resistance. In spite of its extremely limited benefit,
large doses of insulin are sometimes used in Type II patients in an attempt
to overcome insulin resistance and restore normoglycemia, however this may be
just adding to a hyperinsulinemia problem.

Some studies clearly demonstrate the direct correlation between a decrease
in insulin doses and a corresponding drop in blood pressure without deterioration
in glucose control.[vii]

Hyperinsulinemia, insulin resistance and glucose intolerance are the most prominent
characteristics of Type II diabetes and Type II patients almost exclusively
develop primary hypertension, which also shares identical symptoms.

We know that exercise; diet modification and weight loss decreases both elevated
blood pressure and glucose tolerance. One of the many ways this type of non-pharmaceutical
treatment may accomplish these improvements is through an increase in insulin
sensitivity.

This action will cause a decrease in insulin resistance, which in turn will
cause a reduction in insulin output. Correcting hyperinsulinemia, the primary
root cause of the related conditions, would ultimately lead to improvements
in both Type II diabetes and primary hypertension. There are trials that suggest
that this process may be expedited with the uses of two trace minerals that
enhance glucose uptake, chromium and vanadyl sulfate.

There are other conditions that can contribute to hypertension and treatments
used to correct them.

Sodium in the form of common table salt increases blood pressure in those with
hypertension with abnormal renal sodium handling characteristics. The removal
of added salt in specific individuals can cause up to a 10-15% decrease in overall
blood pressure.

Unsaturated fat to saturated fat intake ratio should be as high as conceivably
possible. Monounsaturated fat is the preferred unsaturated fat for both its
lower blood sugar impact and its ability to decrease blood pressure.

Caffeine has a number of undesirable side effects that may aggravate the hypertensive
condition through increased calcium excretion.[viii] There appears to be a direct
relationship between low serum levels of calcium and primary hypertension.[ix]
[x] There is evidence that impaired calcium metabolism and elevated urinary
calcium levels may affect blood pressure regulation in hypertensive patients.[xi]
[xii] Calcium supplements in the amount of 2 grams a day in the form of calcium
lactate may prove helpful in blood pressure reduction. Potassium also has a
role in hypertension treatment, for it will cause a modest reduction in blood
pressure.[xiii] [xiv] Its intake should be in a higher ratio to that of sodium
to be effective.

Magnesium has one of the strongest correlations between low serum levels and
insistences of hypertension.[xv] [xvi] [xvii] The uses of a one-gram a day dietary
supplement of magnesium may induce a significant reduction in blood pressure.

Coenzyme Q10 has been extremely effective in reducing elevated blood pressure
in hypertension as well as improving other serious cardiac conditions.[xviii]
[xix] [xx] [xxi] A total daily dose between 120-200 mg seemed to deliver the
most benefit.

The amino acid L-carnitine demonstrated its therapeutic value in several clinical
trials with primary hypertensive patients.[xxii] [xxiii] It reduced symptoms
and like all other supplements was well tolerated with no side effects. The
doses varied between 2 to 4 grams a day.

Several studies using vitamin B6 to treat primary hypertension had very favorable
results in decreasing blood pressure.[xxiv] [xxv]

The involvement of free radicals and elevated oxidation rates, which are common
in diabetes, brings to the forefront the role of antioxidants. There appears
to be a correlation between low levels of serum antioxidants and the development
of primary hypertension, atherosclerosis and ischemic heart disease.[xxix] [xxx]

Beta carotene and vitamin A are included in some of these studies, but most
of the attention has been focused on vitamins C and E.[xxxi] [xxxii] [xxxiii]
These vitamins seem to offer at the very least protection from the fore mentioned
conditions.

Another link to cardiovascular problems that can affect diabetes patients,
and the general population is serum homocysteine levels. Over three decades
ago a Dr. Kilmer McCully, a Harvard educated researcher, discovered that high
levels of serum homocysteine were a direct link to heart disease. At that time
though, everyone was focusing their attention on the dangers of serum cholesterol
and developing drugs to combat this condition in hopes to reduce associated
deaths. It is interesting to note that almost half of the people that suffer
heart attacks have normal serum cholesterol, so there must be other pathologies
involved. Cholesterol occlusion can be the end result of a process that first
begins damage to the intima lining of the vessel due to an inability to repair
it from vitamin deficiencies. This damage causes vascular seepage and the body,
without raw materials to effect proper repair, mobilizes fibrin and cholesterol
to construct a patch and as long as the vitamin deficiency exists cholesterol
keeps being produced. I have seen studies and have personally observed a decrease
of nearly 60 points in total cholesterol from just an increase in vitamin C
and E with no changes in diet, exercise or medications.[xxxiv] [xxxv] [xxxvi]
It was noted that even infants could die from cardiac failure with the only
identifiable cause being elevated homocysteine levels. So, the time required
for the progression of this condition is extremely brief. Dr. McCully also discovered
that homocysteine levels are kept in check effectively and also inexpensively
by vitamins B6, B12 and folic acid.[xxxvii] [xxxviii]

There are studies that suggest that Type II patients have higher serum homocysteine
levels than both Type I patients and normal controls.[xxxix] One of the several
possible factors that might help explain these results may be that the sulfonylureas
have been known to decrease some B vitamins in diabetes patients. Likewise the
biguanides class of oral hypoglycemics causes a reduction of serum B12 and folic
acid.[xl] [xli] These two classes of oral hypoglycemic drugs are often used
together and may create an environment that can host not only an elevated homocysteine
level, but may be involved in a number of other complications due to the vitamin
loss associated with them.

When we look for the ways to help our hypertensive, diabetic patients we can
begin to evaluate certain nutritional parameters and help maximize each of our
patient’s therapy.

Dr. Brian P. Jakes, Jr., N.D., C.N.C. is a Board Certified Doctor of Naturopathy
as well as a Certified Nutritional Consultant. In his practice, in Mandeville,
LA, Dr. Jakes works with physicians to treat a large number of diabetes patients.
This is an excerpt from his upcoming book; "Diabetes: The Essence Of A
Cure”

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